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INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES

ISSN:23203137

Research Article
AN OPD BASIS FORMULA FOR CALCULATING CREATININE
CLEARANCE
Agarwal A*, Agrawal P, Bansal M, Singh O
Department of Medicine, S.N. Medical College, Agra
ABSTRACT
Many equations have been formulated for calculating the creatinine clearance, but unfortunately all of them are
cumbersome and need scientific calculation. We have come up with a novel method which provides approximate
values of creatinine clearance with the advantage that it uses a formula that makes the CrCl easy to calculate. Since
the normal values of GFR are around 100 for women and 120 for men, we take the numerator as 100 in our
equation. The denominator is decided by the age of the patient according to the age bracket in which they fall.
Our Formula (PRABHATS FORMULA)
CrCl = 100/ [1.3 x S.Creatinine] x [0.8 if female]
if age is between 30-40 years
CrCl = 100/ [1.5 x S.Creatinine] x [0.8 if female] if age is between 41-50 years
CrCl = 100/ [1.8 x S.Creatinine] x [0.8 if female]
if age>51 years
This formula is not valid for the age below 30 years (CKD is rare below this age group) and is only applicable to the
patients of chronic renal failure. Example to show its utility when compared to the standard formulae used to
calculate creatinine clearance: A 60 year old male with CRF weighing 50 kgs with a serum creatinine of 4 mg/dl.
His creatinine clearance would come out to be: (i)Cockroft Gault- 13.89 ml/min (ii)MDRD- 16.4 ml/min
(iii)Prabhats formula- 13.88 ml/min. Thus, it is evident that using our formula (Prabhats formula), the calculated
creatinine clearance is quite similar to the one that we get using other formulae for the same.
Key Words: Creatinine Clearance (CrCl), Prabhats formula, Cockroft Gault Equation, MDRD, GFR

INTRODUCTION
There are multiple methods of assessing
kidney
function.
GFR
(Glomerular
Filtration Rate) is considered to be the most
reliable index amongst them as its levels
correlate the most with the likelihood of
developing complications of kidney disease.
The fact that GFR<60 ml/min/1.73 m2 is
itself sufficient to make the diagnosis of
chronic kidney disease, even in the absence
of other markers of renal injury bears
testimony to this fact1. Earlier inulin was
used, which has now been replaced by
iothalamate, a radio labelled molecule, for
measuring GFR but both of these are rarely

used today because these measurements are


cumbersome and impractical.
Because of the above disadvantages, the
concept of creatinine clearance arose.
Serum creatinine concentrations are the
most commonly used indicator for assessing
kidney function1. Creatinine clearance
(CrCl) is calculated from the creatinine
concentration in the collected urine sample
(UCr), urine flow rate (V), and the plasma
concentration (PCr). Since the product of
urine concentration and urine flow rate
yields creatinine excretion rate, which is the

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INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES


ISSN:23203137

rate of removal from the blood, creatinine


clearance is calculated as removal rate per
min (UCrV) divided by the plasma
creatinine concentration14.
Creatinine clearance CrCl= [Ucr x V]/ Pcr
However, the above method is not correct
since the values of serum creatinine are
dependent on muscle mass, due to which its
same values can result in different GFRs in
different individuals. To eliminate this
problem, many equations have been
formulated which take into account various
parameters that correlate with muscle mass
like age, sex, race and body weight. Two
such formulations that are endorsed by the
National Kidney Foundation are the
Cockroff Gault equation and the MDRD
(Modification of Diet in Renal Disease)
equation.
We have come up with a novel method,
Prabhats Formula, which provides
approximate values of creatinine clearance
with the advantage that it uses a formula that
makes the CrCl easy to calculate and
therefore can be done by oneself and used in
the OPD basis without being dependent on
other parameters, a calculator or a computer.

CrCl = 100/ [1.5 x S.Creatinine] x [0.8


if female]
if age is between 41-50 years
CrCl = 100/ [1.8 x S.Creatinine] x [0.8 if
female]
if age>51 years
This formula is not valid for the age below
30 years (CKD is rare below this age group)
and is only applicable to the patients of
chronic renal failure.
RESULTS:
The utility of the equation can be seen in the
following examples, by comparing the
results obtained with it to the standard
formulae used to calculate the creatinine
clearance.
Example 1: A 60 year old male with CRF
weighing 50 kgs with a serum creatinine of
4 mg/dl
His creatinine clearance would come out to
be:
(i)cockroft gault- 13.89 ml/min
(ii)MDRD- 16.4 ml/min
(iii)Prabhats formula- 13.88 ml/min

MATERIALS AND METHODS:


Since the normal values of GFR are around
100 for women and 120 for men, we take the
numerator as 100 in our equation. The
denominator is decided by the age of the
patient according to the age bracket in which
they fall.
Our Formula (PRABHATS FORMULA)
CrCl = 100/ [1.3 x S.Creatinine] x [0.8 if
female]
if age is between 3040 years

Example 2: A 45 year old female with CRF


weighing 45 kgs with a serum creatinine of
10 mg/dl
Her creatinine clearance would come out
to be:
(i)cockroft gault- 5 ml/min
(ii)MDRD- 4.5 ml/min
(iii)Prabhats formula- 5.33 ml/min

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INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES


ISSN:23203137

Example 3: A 33 year old male with CRF,


weighing 52 kgs with a serum creatinine of
9 mg/dl
His creatinine clearance would come out to
be:
(i)cockroft gault- 8.6 ml/min
(ii)MDRD- 7.2 ml/min
(iii)Prabhats formula- 8.54 ml/min
Thus, it is evident that using our formula
(Prabhats formula), the calculated
creatinine clearance is quite similar to the
one that we get using other formulae for the
same.
DISCUSSION:
There are multiple methods of assessing
kidney
function.
GFR
(Glomerular
Filtration Rate) is considered to be the most
reliable index amongst them as its levels
correlate the most with the likelihood of
developing complications of kidney disease.
The fact that GFR<60 ml/min/1.73 m2 is
itself sufficient to make the diagnosis of
chronic kidney disease, even in the absence
of other markers of renal injury bears
testimony to this fact1. GFR measures the
rate at which fluid is filtered across the
glomerular basement membranes into the
renal tubules and the GFR measured is
actually the sum of all the single nephron
GFRs1. The GFR may be relatively
preserved even in renal injury as the non
injured nephrons may show compensatory
increase to make up for the loss of GFR
from the injured ones. Earlier inulin was
used, which has now been replaced by
iothalamate, a radio labelled molecule, for
measuring GFR but both of these are rarely
used today because these measurements are
cumbersome and impractical.
Because of the above disadvantages, the
concept of creatinine clearance arose.
Serum creatinine concentrations are the
most commonly used indicator for assessing

kidney function1. Creatinine is produced in


the body in the muscles by the breakdown of
creatinine phosphate, and excreted by the
kidney. It is completely filtered from the
blood by the glomerulus and some amount is
actively secreted, because of which it over
estimates GFR by 15-20%. Any decrease in
the renal function, therefore, leads to an
increase in serum creatinine levels.
Creatinine clearance (CrCl) is calculated
from the creatinine concentration in the
collected urine sample (UCr), urine flow rate
(V), and the plasma concentration (PCr).
Since the product of urine concentration and
urine flow rate yields creatinine excretion
rate, which is the rate of removal from the
blood, creatinine clearance is calculated as
removal rate per min (UCrV) divided by the
plasma creatinine concentration14.
Creatinine clearance CrCl= [Ucr x V]/ Pcr
However, the above method is not correct
since the values of serum creatinine are
dependent on muscle mass, due to which its
same values can result in different GFRs in
different individuals. To eliminate this
problem, many equations have been
formulated which take into account various
parameters that correlate with muscle mass
like age, sex, race and body weight. Two
such formulations that are endorsed by the
National Kidney Foundation are the
Cockroff Gault equation and the MDRD
(Modification of Diet in Renal Disease)
equation.
1. Cockroff Gault Equation:
It is named after the scientists who first
published the formula, and it employs serum
creatinine measurements and a patient's
weight to predict the creatinine clearance2,3.
CrCl = [(140-age in years) x body weight
(in kg) (x 0.85 if female) / 72] / S.Cr (in
mg/dl)

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2. MDRD:
It stands for Modification of Diet in Renal
Disease and was postulated by Modification
of Diet in Renal Disease study group4. It
estimates GFR using four variables: serum
creatinine, age, ethnicity, and gender5. The
original MDRD used six variables, the
additional ones being the blood urea
nitrogen and albumin levels4. The equations
have been validated in patients with chronic
kidney disease. However both the versions
underestimate the GFR when GFR> 60
mL/min and the equations have not been
validated for use in acute renal failure 6,7.
CrCl = 186 x [S.Cr (in mg/dl)]-1.154 x [(age
in years)]-0.203 x [0.742 if female] x [1.212 if
black]
CrCl = 170 x S.Cr-0.999 x Age-0.176 x [0.762
if female] x [1.180 if black] x BUN-0.170 x
Albumin +0.3
These MDRD equations are to be used only
if the laboratory in which it is being
implemented does not have its serum
creatinine calibrated to isotope dilution mass
spectrometry (IDMS). The above equations
should be multiplied by 175/186 or by
0.94086 when IDMS-calibrated serum
creatinine is used because it is
approximately 6% lower8.
Also since these formulae do not adjust for
body mass, they underestimate GFR for
heavy people and overestimate it for
underweight people.
3. Mayo Quadratic Formula:
This formula was developed by Rule et al 6
in an attempt to better estimate GFR in
patients with preserved kidney function
since the MDRD formula tends to
underestimate GFR in such patients.

CrCl = exp (1.911 + [5.29/S.Cr]


[2.114/S.Cr2] [0.00686 x age] [0.205 if
female])
If serum creatinine is less than 0.8 mg/dL,
the value 0.8 mg/dl should be used.
4. CKD-EPI Formula:
The CKD-EPI (Chronic Kidney Disease
Epidemiology Collaboration) formula was
developed by Levey et al9 and published in
May 2009 and was developed in an effort to
create a formula which more accurate than
the MDRD formula, especially when actual
GFR>60 mL/min/1.73 m2.
Data was pooled from multiple studies to
develop and validate this new equation. 10
studies that included 8254 participants were
chosen initially which were then divided
randomly into 2/3rd for development and the
other 1/3rd for internal validation. For
external validation 16 other studies which
included 3896 participants were included.
Not only did the CKD-EPI equation perform
better than the MDRD equation and was
associated with lesser bias and greater
accuracy, but also was found to provide
improved cardiovascular risk prediction over
the MDRD formula when it was applied to
the middle aged population10.
CrCl = 141 x {min(S.Cr/k,1)a x
max(S.Cr/k,1)-1.209 x 0.993Age x [1.018 if
female] x [1.159 if black]}
Where k is 0.7 for females and 0.9 for
males, a is -0.329 for females and -0.411 for
males

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5. Schwartz Formula:
This formula is specially used in children11,
12
.

and is only applicable to the patients of


chronic renal failure.
REFERENCES:

CrCl = [k x Height in cm]/ S.Cr


Where k is a constant that depends on
muscle mass, which varies with a child's
age:
For the 1st year, for pre-term babies,
K=0.3313 and for full-term infants, K=0.4512
For infants and children of age 1 to 12 years,
K=0.5511
Although many other formulae have been
formulated for calculating the creatinine
clearance, it is evident that all of them are
cumbersome and need scientific calculation.
We have come up with a novel method
which provides approximate values of
creatinine clearance with the advantage
that it uses a formula that makes the CrCl
easy to calculate and therefore can be done
by oneself and used in the OPD basis
without being dependent on other
parameters, a calculator or a computer.
Since the normal values of GFR are around
100 for women and 120 for men, we take the
numerator as 100 in our equation. It is
divided by a denominator according to the
age bracket in which he/she falls.
Our Formula (PRABHATS FORMULA)
CrCl = 100/ [1.3 x S.Creatinine] x [0.8 if
female]
if age is between 3040 years
CrCl = 100/ [1.5 x S.Creatinine] x [0.8
if female]
if age is between 41-50 years
CrCl = 100/ [1.8 x S.Creatinine] x [0.8 if
female]
if age>51 years
This formula is not valid for the age below
30 years (CKD is rare below this age group)

1. Primer on Kidney Diseases, 5th


edition, chapter 2, pages 19-23
2. Cockcroft DW, Gault MH (1976).
"Prediction of creatinine clearance
from
serum
creatinine". Nephron 16 (1):
31
41.doi:10.1159/000130554. PMID 1
244564
3. Gault MH, Longerich LL, Harnett
JD,
Wesolowski
C
(1992).
"Predicting glomerular function from
adjusted
serum
creatinine". Nephron 62 (3):
24956. doi:
10.1159/
000187054
PMID 1436333.
4. Levey AS, Bosch JP, Lewis JB,
Greene T, Rogers N, Roth D (March
1999). "A more accurate method to
estimate glomerular filtration rate
from serum creatinine: a new
prediction equation. Modification of
Diet in Renal Disease Study
Group". Annals
of
Internal
Medicine 130 (6):
46170.doi
10.7326/0003-4819-130-6199903160-00002 PMID 10075613
5. National
Kidney
Foundation
(February 2002). "K/DOQI clinical
practice guidelines for chronic
kidney
disease:
evaluation,
classification,
and
stratification". American Journal of
Kidney Diseases 39 (2 Suppl 1): S1
266. doi:10.1016/S02726386(02)70081-4. PMID 11904577
6. Rule AD, Larson TS, Bergstralh EJ,
Slezak JM, Jacobsen SJ, Cosio FG
(December 2004). "Using serum
creatinine to estimate glomerular
filtration rate: accuracy in good
health and in chronic kidney

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INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES


ISSN:23203137

disease". Annals
of
Internal
Medicine 141(12):
92937. doi:
10.7326/0003-4819-141-12200412210-00009. PMID 15611490
7. Levey AS, Coresh J, Greene T et al.
(August 2006). "Using standardized
serum creatinine values in the
modification of diet in renal disease
study equation for estimating
glomerular filtration rate". Annals of
Internal Medicine 145 (4): 247
54.doi:10.7326/0003-4819-145-4200608150-00004.PMID 16908915
8. GFR MDRD Calculator for
Adults. National Kidney Disease
Education Program. United States:
National Institutes of Health
9. Levey AS, Stevens LA, Schmid CH
et al. (May 2009). "A new equation
to estimate glomerular filtration
rate". Annals
of
Internal
Medicine 150 (9):
604
12. doi:10.7326/0003-4819-150-920090505000006. PMC 2763564. PMID 19414
839
10. Matsushita K, Selvin E, Bash LD,
Astor BC, Coresh J (April 2010).
"Risk implications of the new CKD
Epidemiology Collaboration (CKDEPI) equation compared with the
MDRD Study equation for estimated
GFR: the Atherosclerosis Risk in
Communities
(ARIC)
Study". American Journal of Kidney
Diseases 55 (4): 648-59 doi: 10.1053
/
j.ajkd.2009.12.016.
PMC 2858455. PMID 20189275
11. Schwartz
GJ,
Haycock
GB,
Edelmann CM, Spitzer A (August
1976). "A simple estimate of
glomerular filtration rate in children
derived from body length and plasma
creatinine". Pediatrics 58(2): 259
63. PMID 951142

12. Schwartz GJ, Feld LG, Langford DJ


(June 1984). "A simple estimate of
glomerular filtration rate in full-term
infants during the first year of
life". The
Journal
of
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849
54.doi:10.1016/S00223476(84)80479-5. PMID 6726515
13. Brion LP, Fleischman AR, McCarton
C, Schwartz GJ (October 1986). "A
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filtration rate in low birth weight
infants during the first year of life:
noninvasive assessment of body
composition
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growth". The
Journal of Pediatrics 109 (4): 698
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14. Wikipedia, the free encyclopaedial;
Renal function; Creatinine clearance

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